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Contact Information

I am a new client I am a repeat client
Name:
Nickname:
Phone Number:
(Area Code Required)
E-mail:
Please click this box if you do not want an email
auto-response sent to you from this request.

Requested Session Information

Requested Date:

Monday - 12pm to 6/7ish pm
Tuesday - 12pm to 7/8ish pm
Wednesday - 12pm to 6/7ish pm
Thursday - 12pm to 7/8ish pm
Friday - 12pm to 6pm
Saturday - 1pm to 4pm as advertised

Requested Time:
Alternate Requested Date:
Alternate Requested Time:
While, I will do my best to schedule your prefered time, a secondary time is will be helpful and speed up the scheduling process
Special offers? My Site Special Eros None
Requested Apt Type:
For more details about session types, please click here.

Future Session Wish-List

This screen is for you to select a list of sessions you would generally be interested in or would like to experience in the future.
Filling out this part of the form will allow me to get a feel for what your interests may be, and help further your exploration process.

Getting to know you

This information is purely optional, COMPLETELY confidential, and is used only to help customize your time and preferences.
Age: Marital Status (Very Optional):
Gender: Sexual Orientation:
I will be attending Email Address to recieve Newsletters
Insert my primary email.
Comments, Special Offers, Questions, Requests, and other information you would like to share...
Please note any allergies or medical conditions.